What happened to safe sex

In the debate about who should deliver pregnancy counselling (The Age, January 3, 2007) pro-life and pro-choice voices are being heard. But we seem to be ignoring a third important voice - pro-prevention.

On one hand Mr Abbott is right to be concerned about the number of abortions being performed. But he seems interested only in the “ends”, not the “means”. Pro-life voices seem to be doggedly against contraception and abortion. Isn’t this somewhat oxymoronic?

At the same time we have been witnessing a major explosion of Chlamydia in Australia with reported rates doubling between 2000-2004.

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We have concerning levels of unplanned pregnancies, abortion and sexually transmissible infections, all at the same time. Why don’t we combine our concerns and combine our strategies?

Where is the focus on contraception, including emergency contraception? Where is the focus on access to health care services for young people? Where is the focus on consistent, well supported sexual and reproductive health education for Australia’s young people?

In the United Kingdom, where sexually transmissible infection (STI) rates reached all time highs a couple of years ago, they concluded that sex education was “too little, too late and too biological”. They have taken this seriously and one of their responses has been a startling and innovative condom marketing campaign.

An international comparison of sexual health programs in France, Netherlands, Australia and the US found that STI rates are much lower in France and the Netherlands where school-based sexual health is mandatory.

The International Planned Parenthood Foundation recommends approaches that recognise that young people do have sex lives. The Foundation promotes good sexual and reproductive health education and skills that empower young people. And this is done as an integral part of adolescent development - not as a virtual aside, done half heartedly.

This approach, typified in Scandinavia, Holland and Germany gets the results - lowest rate of teenage pregnancies, no significant changes in the age of first intercourse in 20 years, low rates of HIV and sexually transmissible infections and a reduction in the number of teenage abortions.

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There is often fear that good sexual health education will lead to increased experimentation. Or that promoting the use of condoms will similarly lead to reckless sexual behaviour. The Federal Government says it demands that programs are evidence based. The evidence is clear - all the reviews over the last 20 years show that good sexual health education does not lead to a lowering of the age of first intercourse or an increase in sexually transmissible diseases.

The other area that those trying to reduce the number of abortions might look at is the increasing sexualisation of our national culture. Whether it’s booze (come in a bikini and get free beer), music videos, clothes or ads for Internet dating as you open your emails, sex sells. Unfortunately sexual health doesn’t sell. In other words having sex is being promoted but having it safely and healthily isn’t.

We seem to be ambivalent about sex, as the Latrobe University landmark 2003 sexual health study Sex in Australia points out, “It is everywhere you look, it permeates every aspect of contemporary popular culture. Yet, of our own experiences we are routinely silent.''

I absolutely support the call to reduce abortions. And I support the need to reduce the rising levels of sexually transmissible infections. But if we want to have an impact on the “ends” we have to provide the right “means” - widely accessible and available contraception, a culture of using condoms, and comprehensive sexual and reproductive health education that results in an increase in the age of first intercourse and on-going safer sex.

About the Author

Rob Moodie is Professor of Global Health at the Nossal Institute for Global Health at the University of Melbourne. Between 1998 and 2007 he was the CEO of VicHealth. He is co-editor of three books, including Hands on Health Promotion. He is currently writing a book called Recipes for a Great Life with Gabriel Gate.